Herrero J C, Molina A, Lentisco C, García C, Ortiz M, Mon C, Ortega O, Rodríguez I, Oliet A, Vigil A, Gallar P
Hospital Severo Ochoa, Leganes, Madrid, Spain.
Nefrologia. 2007;27(6):729-36.
Sclerosing Encapsulating Peritonitis (SEP) is a rare but serious complication of continuous ambulatory peritoneal dialysis (CAPD) with a high morbi-mortality. We describe our experience with patients was diagnostic of SEP, their characteristics in CAPD and their clinic evolution after diagnosis. 190 CAPD patients were follow-up during 17 years. Eight patients (4.2%) developed SEP. Average age 45+/-14 years (range 29-64 years), four was male. Time in CAPD was 72+/-29 months (range 24-120 months). All patients have peritonitis previously (mean 3+/-1). We observe a change in peritoneum characteristics (D/P Cr 4), with an average of 0.6+/-0.1 at one year of CAPD, versus 0.82+/-0.08 at the end of CAPD, with statistic significance (p<0.001). There are increases in use of hypertonic bags: 53%+/-28 at beginning versus 91%+/-27 at end, with statistic significance (p<0.009). All patients show tendency to hyperphosphoremia (mean 6.7+/-0.7 mg/dl), with product calcium-phosphorus 68.4+/-8.3. Five patients (62.5%) have a previous renal transplant, one lost due to early graft thrombosis and two lost due to acute rejection. Six patients (75%) have a previous abdominal surgery, although was extra peritoneal in all cases. The diagnosis of SEP was clinic suspicion in all cases, suggestive radiological data (intestinal handle group) and laparoscopy showing SEP (cocoon) with histological confirmation (fibrosis and peritoneal calcification) in four cases. The treatment was medical in six cases associated with surgery in four of them. The medical treatment was tamoxifen and/or corticosteroids, associated with total parenteral nutrition in two patients and enteral nutrition in one. Surgery in six patients: three as urgent surgery (all died) and three as programme surgery (two live still). Etiology of died was: three for sepsis, one for peritonitis after bowel perforation, one for severe problems of nutrition. The average survival of three patients alive was 38+/-17 months, two of them had programme surgery, and one with functioning transplant we opt for conservative treatment. The actuarial survival at 24 months was 51%.
The SEP is a serious entity with high mortality. Although our short experience doesn't can indicate a concrete treatment, our personal impression is that early surgery associated with corticosteroids treatment may improve the prognostic.
硬化性包裹性腹膜炎（SEP）是持续性非卧床腹膜透析（CAPD）的一种罕见但严重的并发症，病死率高。我们描述了我们对诊断为SEP的患者的经验、他们在CAPD中的特征以及诊断后的临床演变。190例CAPD患者随访了17年。8例患者（4.2%）发生了SEP。平均年龄45±14岁（范围29 - 64岁），4例为男性。CAPD时间为72±29个月（范围24 - 120个月）。所有患者既往均有腹膜炎（平均3±1次）。我们观察到腹膜特征发生了变化（D/P Cr 4），CAPD一年时平均为0.6±0.1，而CAPD结束时为0.82±0.08，具有统计学意义（p<0.001）。高渗袋的使用增加：开始时为53%±28，结束时为91%±27，具有统计学意义（p<0.009）。所有患者均有高磷血症倾向（平均6.7±0.7mg/dl），钙磷乘积为68.4±8.3。5例患者（62.5%）既往有肾移植，1例因早期移植血栓形成而失功，2例因急性排斥反应而失功。6例患者（75%）既往有腹部手术史，尽管所有病例均为腹膜外手术。所有病例SEP的诊断均基于临床怀疑、提示性的放射学数据（肠袢组）以及腹腔镜检查显示SEP（茧状），4例经组织学证实（纤维化和腹膜钙化）。6例患者采用药物治疗，其中4例联合手术治疗。药物治疗为他莫昔芬和/或皮质类固醇，2例患者联合全胃肠外营养，1例联合肠内营养。6例患者接受手术：3例为急诊手术（均死亡），3例为计划性手术（2例仍存活）。死亡原因：3例死于败血症，1例死于肠穿孔后腹膜炎，1例死于严重营养问题。3例存活患者的平均生存期为38±17个月，其中2例接受了计划性手术，1例有功能的移植患者我们选择了保守治疗。24个月时的精算生存率为51%。
SEP是一种严重的疾病，死亡率高。虽然我们的经验有限，无法指明具体的治疗方法，但我们个人的印象是，早期手术联合皮质类固醇治疗可能会改善预后。
